While less harmful than conventional cigarettes, e-cigarettes are not inherently harmless:

Nicotine (including nicotine found in vaping juice) is known to alter adolescent brain development and can affect memory and concentration;¹

Vaping by children and youth – especially high-nicotine products like JUUL, which are now marketed in Ontario – increases the risk of nicotine addiction;

Each JUUL pod contains as much nicotine as a pack of cigarettes;

People that use e-cigarettes are likely to also vape cannabis. Among grade 9 to 12 students in Ontario, 32% of past 30 day e-cigarette vapers had also vaped cannabis;

Symptoms of respiratory disease have been observed in people that are young that vape, including coughing, wheezing, and worsening of asthma;2

Use of vaping devices increases the risk of heart disease. Using e-cigarettes every day almost doubles the risk for heart attack;3

Vaping is associated with increased risk of ever smoking, and among youth and young adults, with increased frequency and intensity of subsequent smoking;4

There is substantial evidence that vaping results in symptoms of dependence on vaping devices;5 and

Vaping aerosol contains a number of chemicals with known toxicity.6

The scientific evidence clearly states that e-cigarettes should not be used by people that don’t smoke, and that policies need to be in place to better protect youth. Please accept the following as commentary from Peterborough Public Health on the proposed changes to the regulations of the Smoke Free Ontario Act, 2017 that will both protect youth, and support current e-cigarette users.

Ministry Proposal:

Make the Smoke-Free Ontario Act, 2017 apply to the consumption of cannabis, both medical and recreational

Peterborough Public Health Response:

We agree that harmonizing public smoking policies and subsequent public health interventions to include cannabis for non-medical use will make these policies and interventions easier to deliver and enforce. Tobacco Enforcement Officers within Public Health Units are well-positioned to enforce the new regulations related to public consumption; however, existing funding levels, and training may impact enforcement capacity. We have already begun to receive complaints from local residents concerned about the impact of cannabis smoking in public spaces. Additional resources, including, signage will be needed for both education and enforcement in order to ensure that all our community members continue to be able to access public spaces free from the harms of second hand smoke.

Ministry Proposal:

Prohibit the smoking of cannabis in the same places where the smoking of tobacco and the use of electronic cigarettes are prohibited (e.g., enclosed workplaces, enclosed public places, and other specified places)

Peterborough Public Health Response:

The combustion, inhalation and exposure of tobacco and cannabis has been proven to pose serious health effects, either by firsthand or second hand exposure.7 Moreover, cannabis is a psychoactive product that can both impair and intoxicate a person who uses the substance.8 Permitting the use of cannabis in places where tobacco use is permitted is not recommended due to the health and safety consequences that can come from people being impaired in public.9 “During intoxication, marijuana can interfere with cognitive function (e.g., memory and perception of time) and motor function (e.g., coordination), and these effects can have detrimental consequences (e.g., motor-vehicle accidents).”10 For these reasons, we recommend using a more health protective approach, and treating cannabis like alcohol and limiting the places of use.

Furthermore, people in the process of making a quit attempt are more successful if they aren’t exposed to physical triggers (such as other people smoking) around them.11 Additionally, youth that are exposed to smoking of any substance are more likely to view that as a normal behaviour.12 (Children tend to copy what they observe and are influenced by normality of any type of smoking around them). From the lessons learned from tobacco and alcohol, normalization of cannabis use could lead to increases in rates of cannabis use.

Studies have shown that smoke-free policies can reduce smoking rates, youth initiation rates and increase quit attempts. Smoking restrictions have also been associated with improved health outcomes, such as reductions in heart disease and respiratory illness. We believe the Smoke-Free Ontario Act should serve as a minimum standard, with supports and resources allocated to public health agencies and local municipalities to develop further smoking restrictions through by-laws. Further restrictions on where cigarette, cannabis, and vaping is permitted should be expanded to include other outdoor areas including, but not limited to, street festivals, food festivals, concerts in parks, municipal trails, splash pads, and beaches.

Ministry Proposal:

Permit the display and promotion of vapour products in stores, as long as the display or promotion complies with Division 2 of Part IV of the Tobacco and Vaping Products Act (Canada)

Peterborough Public Health Response:

The research is conclusive about point of sale marketing and its impact on youth uptake of smoking.13 Despite Federal regulations about industry promotion ‘not being appealing to young persons’, the vaping industry is aware that if their products are on display and promoted in places frequented by children and youth (i.e. corner stores, gas station kiosks, etc.) next to ubiquitous and benign products like candy and newspapers, a positive relationship with their brands and products will be formed. Division 2 Part IV of the Tobacco and Vaping Products Act (Canada) does not do enough to protect youth from the promotion of vaping products and should not be the benchmark for Ontario’s regulation. Display and promotion of e-cigarettes should mirror the current tobacco regulations, which prohibit the display and promotion of these types of products.

Ministry Proposal:

The electronic cigarette must be the personal possession of the person holding it, or, if it is supplied by the specialty vape store, a fresh one-time disposable mouthpiece must be used for the sampling.

Peterborough Public Health Response:

Public Health Ontario’s research with regards to e-cigarette sharing and sampling notes that “it is apparent that devices that come in contact with the mouth are candidate sites for harbouring microbial growth, and that sharing of such equipment may increase the risk of virus and pathogen transmission. Although drip tips are designed for individual use only, it is possible that bacteria transmitted to the tips from individual users could transmit further into the e-cigarette, making it a potential reservoir for delivering pathogens to the lungs along with the aerosols produced upon inhalation.”,sup>14 Additionally, as the long term health effects of second hand vapour are unknown, limiting sampling to two people at a time (like in BC) who use their own devices is recommended. This will reduce the amount of second hand vapour in a speciality vape store that will reduce vapour exposure to store employees and patrons, while simultaneously limiting the risk of transmission of disease and infection.

1 U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.2 National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington National Academies Press.3 Alzahrani, T, et al. Association Between Electronic Cigarette Use and Myocardial Infarction. American Journal of Preventive Medicine 2018;000(000):1-7.4 National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington National Academies Press.5 Ibid.6 Vaping [Internet]. Ottawa, ON: Government of Canada; 2018 [updated 2016 Jun 27; cited 2018 Jul 31]. Available from: https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping.html#a1
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough7 https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf8 https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/cannabis9 https://www.camh.ca/-/media/files/pdfs—reports-and-books—research/canadas-lower-risk-guidelines-cannabis-pdf.10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827335/11 https://otru.org/wp-content/uploads/2018/03/2017_SMR_Cessation.pdf12 https://otru.org/wp-content/uploads/2018/03/2017_SMR_Full.pdf13 https://www.tobaccofreekids.org/assets/factsheets/0075.pdf14 https://www.publichealthontario.ca/en/eRepository/ECigarette_Communicable_Drip_Tip_EB_2014.pdf